Comparison of Nonesophageal Eosinophilic Gastrointestinal Disorders with Eosinophilic Esophagitis: A Nationwide Survey

Mayu Yamamoto; Saori Nagashima; Yoshiyuki Yamada; Takatsugu Murakoshi; Yasuyuki Shimoyama; Sakuma Takahashi; Hideyuki Seki; Takashi Kobayashi; Yuichi Hara; Hiromi Tadaki; Norihisa Ishimura; Shunji Ishihara; Yoshikazu Kinoshita; Hideaki Morita; Yukihiro Ohya; Hirohisa Saito; Kenji Matsumoto; Ichiro Nomura

doi:10.1016/j.jaip.2021.06.026

Comparison of Nonesophageal Eosinophilic Gastrointestinal Disorders with Eosinophilic Esophagitis: A Nationwide Survey

J Allergy Clin Immunol Pract. 2021 Sep;9(9):3339-3349.e8. doi: 10.1016/j.jaip.2021.06.026. Epub 2021 Jun 29.

Authors

Mayu Yamamoto¹, Saori Nagashima¹, Yoshiyuki Yamada², Takatsugu Murakoshi³, Yasuyuki Shimoyama⁴, Sakuma Takahashi⁵, Hideyuki Seki⁶, Takashi Kobayashi⁷, Yuichi Hara⁸, Hiromi Tadaki⁹, Norihisa Ishimura¹⁰, Shunji Ishihara¹⁰, Yoshikazu Kinoshita¹¹, Hideaki Morita¹², Yukihiro Ohya¹³, Hirohisa Saito¹², Kenji Matsumoto¹⁴, Ichiro Nomura¹⁵

Affiliations

¹ Division of Eosinophilic Gastrointestinal Disorders, National Research Institute for Child Health and Development, Tokyo, Japan.
² Division of Allergy and Immunology, Gunma Children's Medical Center, Gunma, Japan.
³ Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
⁴ Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan.
⁵ Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan.
⁶ Department of Gastroenterology, KKR Sapporo Medical Center, Hokkaido, Japan.
⁷ Department of Gastroenterology, Fujita Health University Bantane Hospital, Aichi, Japan.
⁸ Department of Gastroenterology, Fukuoka Sanno Hospital, Fukuoka, Japan.
⁹ Department of Pediatrics, National Hospital Organization Yokohama Medical Center, Kanagawa, Japan.
¹⁰ Department of Gastroenterology, Shimane University Hospital, Shimane, Japan.
¹¹ Department of Gastroenterology, Shimane University Hospital, Shimane, Japan; Department of Medicine, Steel Memorial Hirohata Hospital, Himeji, Japan.
¹² Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
¹³ Allergy Center, National Center for Child Health and Development, Tokyo, Japan.
¹⁴ Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan. Electronic address: matsumoto-k@ncchd.go.jp.
¹⁵ Division of Eosinophilic Gastrointestinal Disorders, National Research Institute for Child Health and Development, Tokyo, Japan; Allergy Center, National Center for Child Health and Development, Tokyo, Japan. Electronic address: nomura-i@ncchd.go.jp.

PMID: 34214704
DOI: 10.1016/j.jaip.2021.06.026

Abstract

Background: Eosinophilic esophagitis (EoE) has increased rapidly and has been well characterized. However, no nationwide survey has been conducted regarding non-esophageal eosinophilic gastrointestinal disorders (non-EoE EGIDs), and they remain poorly understood.

Objective: To compare the clinical features and natural histories of non-EoE EGIDs and EoE by using the same questionnaire, for all ages.

Methods: We conducted a nationwide hospital-based survey of patients who visited hospitals from January 2013 through December 2017. We randomly selected 10,000 hospitals that perform endoscopy. We analyzed the demographics, symptoms, gastrointestinal histology, treatments, and natural histories of EoE and non-EoE EGIDs.

Results: A total of 2906 hospitals responded to the questionnaire. We identified 1542 patients and obtained detailed data for 786 patients, consisting of 39% EoE and 61% non-EoE EGIDs. The clinical characteristics were analyzed for patients who met the "definite" criteria that excluded comorbidities. Non-EoE EGIDs showed no gender difference, whereas EoE was male-predominant. Tissue eosinophilia was often seen in the small intestine (62%) and stomach (49%). The frequency of hypoproteinemia was high (27%) in childhood. Children also had more serious symptoms and complications than adults: restriction of daily life activity (P = .009), failure to grow/weight loss (P = .008), and surgery (P = .01). For both diseases, the most common natural history was the continuous type: 66% (95% confidence interval [CI]: 58-74) in EoE and 64% (95% CI: 55-72) in non-EoE EGIDs.

Conclusions: The percentage of persistent patients with non-EoE EGIDs was almost the same as those with EoE. Complications were more frequent in children than in adults.

Keywords: Eosinophilic colitis (EC); Eosinophilic esophagitis (EoE); Eosinophilic gastritis (EG); Eosinophilic gastroenteritis (EGE); Eosinophilic gastrointestinal disorders; Nationwide survey; Natural history; Non–esophageal eosinophilic gastrointestinal disorders (non-EoE EGIDs); Treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Enteritis*
Eosinophilic Esophagitis* / diagnosis
Eosinophilic Esophagitis* / epidemiology
Eosinophils
Gastritis* / diagnosis
Gastritis* / epidemiology
Humans
Male
Surveys and Questionnaires